Menon Vikas, Rajan Tess Maria, Kuppili Pooja Patnaik, Sarkar Siddharth
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
Indian J Psychol Med. 2017 Jul-Aug;39(4):399-406. doi: 10.4103/IJPSYM.IJPSYM_17_17.
Medically unexplained symptoms (MUS) commonly present across the board in medical specialties and are often challenging to treat. Our objective was to assess the efficacy for cognitive-behavior therapy (CBT) in MUS. Electronic search of databases was carried out for published controlled trials in English language peer-reviewed journals from inception till August 2016. Effect sizes for the trials were computed using standardized mean difference, and test was used to assess sample heterogeneity. Pooled mean effect sizes were derived using a random-effects model. Critical appraisal of studies was done using the Cochrane risk of bias assessment tool. A total of 11 trials involving 1235 subjects were included in the study. Ten trials used standard CBT techniques while one studied the efficacy of mindfulness-based CBT technique. The control arms were treatment as usual in five trials, augmented care in four and waitlisted controls in two trials. The pooled mean effect size for CBT was 0.388 (range 0.055-0.806, 95% confidence intervals 0.316-0.461). The value was 0 using a random effects model indicating low heterogeneity among studies. Risk of bias was noted in many included studies. Egger plot intercept indicated potential publication bias. CBT was superior to the waiting list, treatment as usual or enhanced usual care with moderate effect sizes in the treatment of MUS. These findings are impacted by the limited number of studies in this area and questionable methodological rigor of included studies.
医学上无法解释的症状（MUS）在各医学专科中普遍存在，且往往难以治疗。我们的目的是评估认知行为疗法（CBT）对MUS的疗效。对数据库进行电子检索，以查找自创刊至2016年8月在英文同行评审期刊上发表的对照试验。使用标准化均数差值计算试验的效应量，并使用 检验评估样本异质性。采用随机效应模型得出合并的平均效应量。使用Cochrane偏倚风险评估工具对研究进行严格评价。该研究共纳入11项试验，涉及1235名受试者。10项试验采用标准CBT技术，1项试验研究基于正念的CBT技术的疗效。5项试验的对照组为常规治疗，4项试验为强化护理，2项试验为候补对照。CBT的合并平均效应量为0.388（范围0.055 - 0.806，95%置信区间0.316 - 0.461）。采用随机效应模型时 值为0，表明各研究间异质性较低。许多纳入研究中存在偏倚风险。Egger图截距表明存在潜在的发表偏倚。在治疗MUS方面，CBT优于候补名单、常规治疗或强化常规护理，效应量中等。这些发现受到该领域研究数量有限以及纳入研究方法学严谨性存疑的影响。
